Traumatic Brain Injury (TBI) can be caused by impact or blast shock waves. TBI in the civilian population is generally due to car crashes, where an unrestrained (no seatbelt) person's head impacts the windshield. This causes brain contusion, hematoma, diffuse axonal injury, ischemia, and a host of other injury catabolic cascade products. Impact TBI brain injuries have localized bruising and a more obvious area of the injury. Recently, combat injuries are being seen in which field armor has protected the patient well enough that the traumatic brain injuries tend to be from the force of the blast wave itself. Such damage, termed here as blast Traumatic Brain Injuries or bTBI have more subtle, but widespread diffuse axonal brain tissue damage that is more difficult to assess. Currently, bTBI is diagnosed by a diagnostic interview conducted by an experienced neurointensivist or psychologist with special training. This is a subjective diagnosis rendered by a clinician.
There is a need for both an objective and subjective field test to assess the bTBI quickly so the patients can be quickly triaged and treated appropriately. Presently, a key diagnostic for bTBI is whether the patient has been in a blast but doesn't remember the blast. This lack of continuity in the patient's consciousness is called syncope. It is similar to a faint, only with a more powerful exogenous precipitating cause. In the literature, it has been termed as a ‘rebooting’ of the brain after a traumatic halting of all mental processes.
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